| NPI | 1831388149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 003662) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: GA 003662) |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2015-02-05 |